Laaksonen Raisa, Burch Andrea Rahel, Lass Jana, McCarthy Suzanne, Howlett Moninne, Silvari Virginia
Department of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
Hospital Pharmacy, University Hospital Zürich, Zürich, Switzerland.
Eur J Hosp Pharm. 2025 Apr 23;32(3):209-219. doi: 10.1136/ejhpharm-2024-004212.
Patients in intensive care units (ICUs) are susceptible to medication errors (MEs) for many reasons, including the complexity and intensity of care. Little is known about patient safety culture, its relationship to medication safety, and ME prevention strategies used in ICUs. This study explored the attitudes of healthcare professionals (HCPs) working in ICUs or within medication safety towards patient safety culture, medication safety, and factors influencing implementation of ME prevention strategies in ICUs across Europe.
This qualitative study employed focus group discussions; ethical approval was obtained. Invitations to participate were distributed to HCPs working in ICUs or as medication safety officers across Europe. In May 2022, online focus group discussions were conducted. Discussions were transcribed verbatim and analysed. The framework analysis employed was inductive, systematic and transparent, and completed through a collaborative and iterative process.
Three nurses and 11 pharmacists, from seven different countries, participated in three focus group discussions. There was a sense of improvement in blame culture leading to more open culture, although it was not the case for all participants. Blame culture, when present, was thought to be prevalent among more senior ICU staff and hospital managers. Facilitators for improving medication safety included communicating with HCPs and providing feedback on MEs and ME prevention strategies, interprofessional working without hierarchies, and having a 'good' culture and environment. Barriers included lack of engagement of HCPs and their attitudes towards medication safety, and an existing blame culture. Participants reported 25 different ME prevention strategies in use including: assessing knowledge; teaching and training; auditing practice; incident reporting; and involvement of pharmacists.
This study examined the attitudes of HCPs on patient safety culture and medication safety in the ICU setting in Europe and gained their insight into facilitators and barriers to the implementation of ME prevention strategies to improve medication safety.
重症监护病房（ICU）的患者由于多种原因易发生用药错误（ME），包括护理的复杂性和强度。关于患者安全文化、其与用药安全的关系以及ICU中使用的ME预防策略，人们知之甚少。本研究探讨了在ICU工作或从事用药安全工作的医疗保健专业人员（HCP）对患者安全文化、用药安全以及影响欧洲各地ICU中ME预防策略实施的因素的态度。
本定性研究采用焦点小组讨论；获得了伦理批准。向欧洲各地在ICU工作或担任用药安全官员的HCP分发了参与邀请。2022年5月，进行了在线焦点小组讨论。讨论内容逐字记录并进行分析。采用的框架分析是归纳性的、系统的和透明的，并通过协作和迭代过程完成。
来自七个不同国家的三名护士和十一名药剂师参加了三次焦点小组讨论。虽然并非所有参与者都是如此，但责备文化有改善的趋势，导致文化更加开放。责备文化若存在，被认为在ICU的高级工作人员和医院管理人员中更为普遍。改善用药安全的促进因素包括与HCP沟通、提供关于ME和ME预防策略的反馈、无等级制度的跨专业合作以及拥有“良好”的文化和环境。障碍包括HCP缺乏参与及其对用药安全的态度，以及现有的责备文化。参与者报告了正在使用的25种不同的ME预防策略，包括：评估知识；教学与培训；审核实践；事件报告；以及药剂师的参与。
本研究调查了欧洲ICU环境中HCP对患者安全文化和用药安全的态度，并深入了解了实施ME预防策略以改善用药安全的促进因素和障碍。
